Project Summary: This Mentored Career Development Award will allow Dr. Alisa Busch, a psychiatrist, to further develop her mental health services research skills and conduct clinically-relevant and policy significant research examining factors that explain the quality of usual care for bipolar disorder (BPD). The specific aims of this career development proposal are to: 1) develop greater understanding of statistics, health economics and mental health systems/organizational arrangements and their application in mental health services research;2) acquire further knowledge of clinical research issues pertaining to BPD and comorbid substance use disorders;and 3) expand knowledge of patient (including race/ethnicity), provider, treatment, financing and organizational characteristics associated with BPD usual care quality. In this undertaking, Dr. Busch will be guided by her sponsor Richard Frank, Ph.D., co-sponsors Gary Sachs, M.D. and Sharon-Lise T. Normand, Ph.D., and non-paid consultants Arnold Epstein, M.D., Howard Goldman, M.D., M.P.H., Ph.D., Shelly Greenfield, M.D., M.P.H., Thomas McGuire, Ph.D. and Roger Weiss, M.D. Study 1 examines patient, provider and treatment characteristics associated with outcomes in a national multi-site clinical effectiveness trial for BPD Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Study 2 matches STEP-BD participant characteristics with those of a privately insured usual care BPD population;then describes quality, simulates outcomes, and examines the association between outcomes and organizational/financial arrangements in the usual care BPD population. Study 3 uses STEP-BD data to explore the association between site-specific characteristics and quality. The proposed career development plan will provide Dr. Busch the training, mentoring, time and resources needed to develop skills that will position her to lead independent research on examining quality in usual care systems. Relevance: Existing literature on usual care quality for BPD is scant but suggests quality concerns. From a public health policy perspective, exploring and removing barriers to usual care quality is critical. This proposal examines factors that explain the quality of usual care for BPD.